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Pediatrics > Heart diseases > Flashcards

Heart diseases Flashcards

1
Q

Peak age of RHD

A

5-14 years

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2
Q

Pathogenesis of RHD

A

From Group A Beta hemolytic strep pharyngitis to Rheumatic fever and Rheumatic Heart Disease

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3
Q

Jones Criteria - Major and Minor

A

Major
Arthritis (Migratory poly arthritis)
Carditis
Erythema Marginatum
Subcutaneous nodules - of joints
Sydenham chorea (in someone who’s had rheumatic fever)

Minor
Arthralgia (pain without inflammation)
Fever
Elevated acute phase reactants ( CRP, ESR)
Prolonged PR interval

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4
Q

Evidence of Group A Beta Hemolytic Strep + Diagnosis

A

Positive throat swab
Elevated Anti-Streptolysin O Titre
Streptococcal antibody positive

2 major or 1 major + 2 minor + evidence of GABHS

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5
Q

History Presentation of RHD

A

Rarely in RF stage
Often in acute heart failure stage
Dyspnea
Peripheral edema
Wasting
Orthopnea
PND
No fever (if present rule put Pneumonia and other infections)

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6
Q

Auscultation of RHD

A

Murmur of Mitral regurgitation (pan systolic @apex-axilla)
Mitral stenosis (diastolic)
Aortic incompetence murmur ( diastolic)

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7
Q

Investigations for RF

A

CBC
ESR
C reactive protein
Throat culture
ASO Titre
CXR
ECG
Echocardiogram

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8
Q

Investigations for RHD

A

CXR (mitralisation of left ventricle)
ECG - LAE, LVH
Echocardiogram (diagnostic)

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9
Q

Treatment of RF

A

Carditis - Steroids
Arthralgia/Arthritis - Aspirin, NSAIDs
Sydenham’s chorea - Penicillin (to treat GABHS)
Supportive treatment

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10
Q

Treatment of RF

A

Treat Heart failure
Diuretics - Lasix
ACEI

To eradicate GABHS - Penicillin
Surgery (for bad regurgitation leading to Pulmonary hypertension) - Valvopathy + Drug treatment failure. Delay as long as possible.

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11
Q

RF Community Prevention

A

Community prevention - improve economic and environmental status

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12
Q

1 Prevention of RF

A

1 Prevention-
Screening and treating GABHS carriage with penicillin
= 27kg: Phenoxymethylpenicillin 250mg 2/3 times daily for 10 days

> 27kg: Phenoxymethylpenicillin 500mg 2/3 times daily for 10 days
OR
Amoxicillin 50mg/kg per day for 10 days
OR

= 27kg:IM benzathine benzylpenicillin 600 000IU stat
>27kg IM benzathine benzylpenicillin 1,200 000 IU stat

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13
Q

2• Prevention of RF (RF+/- RHD)

A

=27kg: Phenoxymethylpenicillin 250mg 2/3 times daily
> 27kg:Phenoxymethylpenicillin 250mg 2/3 times daily
OR
= 27kg: IM benzathine benzylpenicillin 600 000 IU stat
> 27kg: IM benzathine benzylpenicillin 1,200,000 stat
Given for life

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14
Q

Differentials for RF

A

Other collagen vascular diseases
Juvenile rheumatoid arthritis
SLE

Post infectious arthritis - eg. Gonococcal arthritis
Congenital heart disease
Viral myocarditis/pericarditis

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15
Q

EMF

A

Thickening of the endocardium of the ventricles

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16
Q

Clinical manifestation of EMF

A

Right ventricle
Hepatomegaly
Raised JVP
Ascites (massive)
Minimal peripheral edema
Often no murmur - or Tricuspid regurgitation murmur
Perineal hyperpigmentation

Left
MR murmur
Signs of left heart failure

Bilateral (most common)
Signs of both right and left EMF

17
Q

Investigations for EMF

A

No specific investigation
*Eosinophilia (common)
*Hypoprotenemia (advanced stage)

ECG
*LAE
*RAE
*.Others (non-specific)
Atrial fibrillation (30% of advanced cases)

CXR
*Cardiomegaly

Echocardiogram
*RAE
*LAE

18
Q

Treatment of EMF

A

Medical
Acute disease - Steroids
Heart failure - Diuretics, ACEI, Beta blockers - spirinolactone, potassium sparing , oral anticoagulants

Surgical
Resect the fibrous endocardium
Correct the AV valve abnormalities

19
Q

Differential Diagnosis of EMF

A

RHD
Dilated Cardiomyopathy
Constrictive pericarditis
Tuberculous pericarditis
Endocardial fibroelastosis
Loeffler endocarditis - because of eosinophilia
Ebstein anomaly
Hypertrophic cardiomyopathy

20
Q

Prognosis of EMF

A

Poor
Most die within 2 years (maybe 5 years)
Recurs after surgical therapy
Cause of death - heart failure, thrombosis-embolic phenomenon- stroke, pulmonary embolism

21
Q

Presentation of Pericarditis

A

Viral
Fever
Chest pain
Friction rub

Bacteria
Toxic
High fevers
Irritability
Chest pain

Pediatrics (12 decks)

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